Promoting reflection on bioethics and research ethics issues in Sub-Saharan Africa

Friday, January 10, 2014

Minimizing exploitation of developing world researchers

When many people think of research ethics, they naturally think of issues surrounding the treatment of research participants by researchers. Are the latter harming the former, deceiving them, exploiting them? Just as it has taken a long time to understand medical ethics as involving something beyond the physician/patient relationship, it has taken some time to conceive research ethics as the study of the ethical issues involved in the whole research enterprise, from the 'micro' level of the consent process to the 'macro' level of research funding priorities or the geopolitics of global health research.

It is refreshing for this reason to see a short piece in Nature Medicine on the issue of the exploitation of health researchers in developing countries. The involvement of local collaborators in research conducted in the developing world is commonly regarded as ethically optional. And there is data to support claims that developing world researchers, when they are involved in research projects (sponsored and commonly driven by external agencies and investigators), often are not named as co-authors of articles publishing the results. To put it brutally, local researchers are typically considered good enough to recruit participants, to collect data, to act as diplomats with local institutions, and to sell the study to local communities. They are implicitly regarded, much of the time, as not good enough to design studies, act as principal investigators or be first authors on research articles. Those privileges go preponderantly to outside researchers from more powerful institutions and nations. So not only research participants in developing countries stand to be exploited in global health research: local researchers may also appear as 'vulnerable populations' in this sense.

Shuchman et. al. offer a number of mechanisms to minimize this form of exploitation. They argue that the WHO should take the lead in urging journals to require local authorship, and for research ethics committees to consider local research collaboration as a component of what constitutes ethical research. More than another code of conduct of scientists is needed. But I think the roots of this problems lie much deeper. Global political, social and economic disparities boil down to weak research and education infrastructures in developing countries. It is fine in practice to say that local researchers should be treated as equals, but if the latter have not had the same resources or opportunities, it is very hard for them to perform as equals. It may also be hard to them to perform as equals when their developed world collaborators are their bosses, or at least those who manage the pursestrings. The situation is made more complex when publication of scientific articles do not have the same weight in all cultural contexts. In countries like the USA, peer-reviewed articles are the coin of the realm, and your promotion and tenure relies heavily on your publication record. But this inordinate stress on publication for career development is not the case everywhere. In short, while the goal is a worthy one, the obstacles to researchers in collaborative global health research being genuine equals can sometimes be quite daunting.